title: Design of admission medication reconciliation technology: a human factors approach to requirements and prototyping.
abstract: OBJECTIVE
  Our objectives were to (1) develop an in-depth understanding of the workflow and information flow in medication reconciliation, and (2) design medication reconciliation support technology using a combination of rapid-cycle prototyping and human-centered design.
  
  
  BACKGROUND
  Although medication reconciliation is a national patient safety goal, limitations both of physical environment and in workflow can make it challenging to implement durable systems. We used several human factors techniques to gather requirements and develop a new process to collect a medication history at hospital admission.
  
  
  METHODS
  We completed an ethnography and time and motion analysis of pharmacists in order to illustrate the processes used to reconcile medications. We then used the requirements to design prototype multimedia software for collecting a bedside medication history. We observed how pharmacists incorporated the technology into their physical environment and documented usability issues.
  
  
  RESULTS
  Admissions occurred in three phases: (1) list compilation, (2) order processing, and (3) team coordination. Current medication reconciliation processes at the hospital average 19 minutes to complete and do not include a bedside interview. Use of our technology during a bedside interview required an average of 29 minutes. The software represents a viable proof-of-concept to automate parts of history collection and enhance patient communication. However, we discovered several usability issues that require attention.
  
  
  CONCLUSIONS
  We designed a patient-centered technology to enhance how clinicians collect a patient's medication history. By using multiple human factors methods, our research team identified system themes and design constraints that influence the quality of the medication reconciliation process and implementation effectiveness of new technology.
  
  
  BACKGROUND
  Evidence-based design, human factors, patient-centered care, safety, technology.
authors.affiliation: CORRESPONDING AUTHOR: Blake J. Lesselroth, MD MBI FACP; Director, Portland Patient Safety Center of Inquiry; Portland VA Medical Center, Department of Medicine; Mail Code: P3 MED; 3720 SW US Veterans Hospital Drive; Portland, Oregon, 97239; blake.lesselroth@va.gov; (503) 220-8262, ext. 55998; fax (503) 721-7807.
authors.forename: Blake J
authors.initials: BJ
authors.lastname: Lesselroth
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adams
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tallett
authors.forename: Scott D
authors.initials: SD
authors.lastname: Wood
authors.forename: Amy
authors.initials: A
authors.lastname: Keeling
authors.forename: Karen
authors.initials: K
authors.lastname: Cheng
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Church
authors.forename: Robert
authors.initials: R
authors.lastname: Felder
authors.forename: Hanna
authors.initials: H
authors.lastname: Tran
mesh_terms: D006801:Humans; D008508:Medication Errors; D059065:Medication Reconciliation; D061214:Patient Safety; D018802:Patient-Centered Care; D010595:Pharmacists; D057188:Workflow